Provider Demographics
NPI:1255380705
Name:EDDY, PHYLLIS JEAN (LMHC)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:JEAN
Last Name:EDDY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 DENNLER DR
Mailing Address - Street 2:
Mailing Address - City:ALLEMAN
Mailing Address - State:IA
Mailing Address - Zip Code:50007-9809
Mailing Address - Country:US
Mailing Address - Phone:515-250-7069
Mailing Address - Fax:515-964-2432
Practice Address - Street 1:1100 DENNLER DR
Practice Address - Street 2:
Practice Address - City:ALLEMAN
Practice Address - State:IA
Practice Address - Zip Code:50007-9809
Practice Address - Country:US
Practice Address - Phone:515-250-7069
Practice Address - Fax:515-964-2432
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00922101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health